Bacteria and Bubbles

Once again, I’m in a doctor’s waiting room. This, however, is a far cry from the spacious, trellis and flower muraled room at the breast center. A far cry from the comfy chairs tucked in quiet nooks at the plastic surgeon’s office. A far cry from the bright, windowed drip room at the oncology center. Here at the infectious disease specialist, we patients sit elbow to elbow – with our various diseases – in straight-backed chairs that encircle the room.

A large, low, table strewn with magazines squats before us, its offerings within easy reach of every chair.

Four seats over from me, a heavy blond woman has propped her swollen, scarlet-red leg on a pillow. A cadaverous elderly woman five seats to my left smiles kindly in my direction. The friendly Hispanic woman next to me reveals, after we’ve chatted for twenty minutes or so – breath-to-breath – that she’s “not feeling too good. Kinda achy and flu-ish.”

Great. My smile remains in place, but I excuse myself to go to the ladies room. I’m sure there will be a hefty bottle of anti-bacterial soap in there. An exploratory sniff as I leave the waiting room does not reveal the scent of Purell, although a constant, cleansing mist of the same, wafted through the air system would seem an excellent idea.

After I wash my hands with plenty of foam and hot water, I gingerly re-take my seat, wondering what disease might have occupied this chair before me. Consumption? T.B.? Swine flu?

I select a well-thumbed People magazine and mentally flash on all of those thumbs. I sigh. I will wait a little while before dashing back to the bathroom and the anti-bacterial soap.

Needless to say, I’m not here today doing research. I have an infection myself – a fierce purple redness in the site of my former right breast that started with a fever a week ago. When I asked my sister-in-law Deb, a nurse practitioner, how I might have contracted this, she said, “Bacteria can sneak through any tiny opening in the skin. The chemo has compromised your immune system and you have two foreign bodies in place which are susceptible to attack.” My implants. And they are the cause for worry. I met with Dr. Philipson and Dr. Alton, my surgeons, at the hospital yesterday and they explained that a bacterial film could form on the implant requiring its removal if the infection persisted. After one look at my purplish skin, they sent me upstairs for an immediate intravenous anti-biotic and set up this appointment with the infectious disease specialist.

After a two-hour wait, I meet the doctor. He is boyishly effervescent, swarthy-skinned, smiling and handsome. He examines my flaming skin and prescribes a two-week course of self-administered IV anti-biotics. Yet another fascinating new experience to add to my medical journey.

After a quick session with the anti-bacterial soap and hot water in the rest room, I head home to await the infusion nurse.

Dave, meanwhile, has been out purchasing a squadron of germ-fighting soaps. I grew up with a pediatrician and a mother who believed, rightly I think, that children needed a daily portion of dirt to build immunities. In my current state, however, I am a hand-washing machine. Why, who knows which door knob or encounter at the grocery store, school, or a party initiated this infection? So Dave arrives home from Shaws with an impressive supply of anti-bacterial pump soaps for the kitchen and bathroom sinks, and anti-bacterial Dial soap for the showers. I have individually wrapped, Purell-soaked, towelettes for the car and my pocket-book, as well as a mini-bottle for my desk at school. I am sick at the thought that I could have prevented this infection through hyper-hygiene. Never before has health seemed such a responsibility.

Shortly after two large grocery bags of medications, tubing, alcohol swabs and syringes are deposited on my kitchen counter by an affable, but sweaty, deliveryman, Nurse Nicole arrives. She is pleasant and efficient as she lays out the series of saline flushes, meds and anti-coagulants that I will self-administer. She slides an IV pole to its full height (my own IV pole!) and untangles a five-foot length of tubing studded with clips and dials. Dave joins us with pen and paper in hand and the two of us scribble step-by-step notes as Nicole explains the process.

To start off, she affixes a needle access to the port that was installed in my chest three weeks ago for chemo. A small blue nozzle, or clave, is suspended from the port and I will connect the various meds to that clave for each infusion. As Nicole cautions me to wipe the clave carefully with alcohol between each stage of the process and warns me not to touch this plastic pointy thing to that plastic screw-top thing, my unease grows. Thank God Dave is writing down every step. Thank God I am reasonably agile of mind and fingers. What if I were eighty and alone?

Nicole guides me through saline flushes, a push-medication, and the tricky preparation of the drip IV. Once the drip is underway, I notice bubbles in the IV line. There’d been bubbles in the syringes as well and Nicole had demonstrated how to pull down the plunger and then express, slowly, a few drops of liquid before injecting whatever fluid it might be into my chest, but bubbles remained anyway.

“Don’t worry about them,” Nicole reassures me as I point to the line. “You need, oh, six inches of air before you have a problem.”

“But on T.V…”

“Yes, well, you don’t have to worry.”

“What are the chances I’ll kill myself with bubbles?’

“Not gonna happen,” says Nicole as she packs up supplies, pulls a pen out of her purse and proceeds to sift through pages of paperwork.

Dave and I have our lists and Nicole gives me a typed version as well. Still, I’m nervous about doing this on my own; day after tomorrow, Dave will be back at work. I’ll be alone with my IV pole and drip, scanning for that six inches of air. But the amazing thing is, despite the despair I felt initially about this infection, the possibility of losing the implant, and the discomfort of this needle access on my chest for two weeks….I know I can do it.

I have spent my life worrying about just about everything; I have brooded, Eeyorish, over my lists and obligations. But I have learned something about myself over the past six months – I am more resilient than I’d thought. Cancer, chemo and infection are hard, and yet after the initial reel into darkness with each complication, I bounce back. With Dave, friends and family as buoys, my strength and spirits remain fortified, afloat.